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Anatomy of the Arteries of the Lower Limb Anatomie Der Arterien: Untere Extremität

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Anatomy of the Arteries of the Lower Limb Anatomie Der Arterien: Untere Extremität Schwerpunktthema Anatomy of the arteries of the lower limb Anatomie der Arterien: Untere Extremität Author Christoph Kalka Affiliation ABSTRACT Marienhospital Brühl Anatomy of the vessels of the human body, their morphology Key words and haemodynamics are integral elements of vascular medi- vessel anatomy, iliac arteries, arteries of the lower limb cine. Specifically, a dedicated knowledge of the vessel anato- my is essential for a correct diagnosis and further diagnostic Schlüsselwörter and therapeutic procedures. This article shows the course of Gefäßanatomie, Beckenarterien, Beinarterien the arteries of the lower limb in relation to the bones, their projection to the skin, the positioning of the ultrasound probe Bibliography and the normal findings in plain ultrasound as parallel images. Phlebologie 2020; 49: 363–377 DOI 10.1055/a-1246-4236 ZUSAMMENFASSUNG ISSN 0939-978X Anatomie, Morphologie und Hämodynamik sind elementare © 2020. Thieme. All rights reserved. Bausteine der Gefäßmedizin. Insbesondere die Kenntnis der Georg Thieme Verlag KG, Rüdigerstraße 14, Anatomie der Arterien der unteren Extremität ist für weiter- 70469 Stuttgart, Germany führende diagnostische Maßnahmen wie die farbkodierte Correspondence Duplexsonografie von großer Bedeutung. Der vorliegende PD Dr. med. Christoph Kalka Artikel zeigt pragmatisch in parallelen Bildern den anatomi- Innere Medizin 1, Angiologie und Kardiologie, Marienhospital schen Verlauf der Beinarterie zum Skelett, die Projektion der Brühl, Mühlenstr. 21–25, 50321 Brühl, Deutschland Anatomie auf die Haut mit der erforderlichen Schallkopffüh- [email protected] rung und den sonografischen Normalbefund. The importance of an accurate knowledge of vascular anatomy is Pelvic arteries evident by from the high prevalence of pathological processes in the arteries of the lower limb. More than 50 % of stenotic lesions in Common iliac artery (Arteria iliaca communis) the vessels, usually atherosclerotic in origin, are to be found in the – leg arteries [1]. This article presents ultrasound scans in conjunc- The common iliac artery has a diameter 7 12 mm it is covered by tion with a visualisation of the course of the blood vessels on the the parietal peritoneum and runs laterally and distally along the surface of the skin (▶ Fig. 1) to give a better understanding of the medial edge of the psoas major muscle without giving off any ▶ anatomy of the arteries of the lower limb [2–4]. significant branches ( Fig. 3). The right common iliac artery crosses over the start of the inferior vena cava (V. cava inferior) and the common iliac veins Aortic bifurcation (Vv. iliacae communes). The left common iliac artery runs anterior and lateral to the left common iliac vein. The common iliac arter- The vascular supply of the lower limb starts with the division of ies can vary between 2 cm and 8 cm in length. Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages. the abdominal aorta into the right and left common iliac trunks At the level of the sacroiliac joint, the common iliac artery (Aa. iliacae communes dextra and sinistra) at the level of the fourth divides into the external and internal iliac arteries. lumbar vertebra (▶ Fig. 2). PLEASE NOTE The diameter of the artery decreases from proximal to distal. A positive correlation has been described between the vessel diameter and body surface area and increasing age. [5] Kalka C. Anatomy of the… Phlebologie 2020; 49: 363–377 | © 2020. Thieme. All rights reserved. 363 Schwerpunktthema Internal iliac artery (Arteria iliaca interna) buttocks, the inner aspect of the thigh, the pelvic floor, the exter- nal genitalia and the anal canal (▶ Fig. 4). Parietal and visceral branches of the internal iliac artery (diameter 4–7.5 mm supply structures in the pelvic wall and sacral canal, the Externa iliac artery (Arteria iliaca externa) The external iliac artery, a large calibre vessel (diameter between 5–10 mm), first continues the course of the common iliac artery on the medial edge of the iliopsoas muscle (▶ Fig. 5). In its subsequent course in a distal direction, the external iliac artery reaches the anterior aspect of the muscle through the vascu- lar lacuna and becomes the common femoral artery (A. femoralis communis). Before entering the vascular lacuna, it gives off the inferior epigastric artery (A. epigastrica inferior) and the deep circumflex iliac artery (A. circumflexa iliaca profunda). PLEASE NOTE Looking for the pelvic arteries is often easier by following the course of the external iliac artery upwards above the inguinal ligament. Tilting the probe laterally allows the origin of the internal iliac artery to be demonstrated. In the groin The main blood vessels and nerves supplying the lower limb pass ▶ Fig. 1 Projection of the course of the aorto-iliac-femoral axis in through the vascular lacuna and the muscular lacuna to reach the the left lower abdomen. The anatomical position of the left iliofe- anterior of the leg as well as leaving the pelvis through the obtura- moral vessels, as determined by ultrasound, has been projected tor canal on the medial aspect. onto the skin and shown by the coloured line. At its bifurcation, the aorta divides into the right and left common iliac arteries (Aa. iliacae communes). After the origin of the internal iliac artery (A. iliaca interna), the external iliac artery (A. iliaca externa) passes beneath Arteries of the legs the inguinal ligament and continues as the common femoral artery Distal to the inguinal ligament, the common femoral artery is the (A. femoralis communis). continuation of the external iliac artery. Branches of the common Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages. ▶ Fig. 2 Aortic bifurcation. a Position of the ultrasound probe just above the umbilicus. b Transverse section through the bifurcation of the aorta. * left common iliac artery, ** right common iliac artery, VIC = right common iliac vein (V. iliaca communis). 364 Kalka C. Anatomy of the… Phlebologie 2020; 49: 363–377 | © 2020. Thieme. All rights reserved. ▶ Fig. 3 Common iliac artery (A. iliaca communis, AIC). a Illustration showing the anatomy of the pelvic vessels with the left common iliac artery showningreen.b Position of the probe to identify the left common iliac artery. The grey line shows the position of the inguinal ligament. c Trans- verse section through the left common iliac artery. *common iliac artery, **common iliac vein. d Longitudinal section through the left common iliac artery. ▶ Fig. 4 Internal iliac artery (A. iliaca interna,AII).a Schematic anatomical representation of the left internal iliac artery, shown in green. b Internal iliac artery seen in its longitudinal axis. c Colour-coding of the same B-mode image to clarify the position of the vessel. femoral artery form the arteries supplying the thigh, lower leg and Deep femoral artery (Arteria profunda femoris) foot. The deep femoral artery, also known as the profunda The deep femoral artery is also known as the profunda femoris. It femoris, supplies the proximal end of the femur, the femoral usually originates from the common femoral artery some 3–6cm shaft, the hip joint and the majority of the thigh muscles. Arteries below the inguinal ligament and runs posterolaterally (▶ Fig. 9). branching from the superficial femoral artery supply the knee, The deep femoral artery supplies a large part of the structures lower leg and foot. in the thigh. The artery lies lateral or posterior to the superficial Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages. femoral artery and runs behind the superficial femoral vessels to Common femoral artery the medial side of the femur, where it passes between the adduc- (Arteria femoralis communis) tors and vastus medialis muscle to reach deeper into the tissues. With a diameter of 5–7 mm, the common femoral artery runs Distal to the femoral bifurcation, the medial circumflex femoral distally between the iliopsoas and pectineus muscles, lying lateral artery (A. circumflexa femoris medialis) usually arises from the to the correspondingly named vein (▶ Fig. 6), and divides into the deep femoral artery and runs towards the medial side of the superficial femoral artery and the deep femoral artery (▶ Fig. 7, 8). neck of the femur (▶ Fig. 8c). The level of the femoral bifurcation may show great variation. In some cases, the femoral bifurcation may be situated very proxi- mally, close to the inguinal ligament. Kalka C. Anatomy of the… Phlebologie 2020; 49: 363–377 | © 2020. Thieme. All rights reserved. 365 Schwerpunktthema ▶ Fig. 5 External iliac artery (A. iliaca externa,AIE).a Schematic anatomical representation of the left external iliac artery, shown in green. b Position of the probe longitudinal to the external iliac artery. c Corresponding B-mode image of the external iliac artery. d Additional colour coding of a segment of the external iliac artery. e Corresponding position of the probe in cross-section. f B-mode image of the external iliac artery with the probe in this position. * external iliac artery, VIE = external iliac vein (V. iliaca externa). Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages. ▶ Fig. 6 Common femoral artery (A. femoralis communis,AFC).a Anatomical representation of the femoral vessels with the left common femoral artery shown in green. b Position of the common femoral artery with the transducer in longitudinal section. c Corresponding B-mode image of the common femoral artery with d colour coding. e Position of the common femoral artery in transverse section and f corresponding B-mode image, showing the common femoral artery (*) and accompanying common femoral vein (V. femoralis communis,VFC). 366 Kalka C. Anatomy of the… Phlebologie 2020; 49: 363–377 | © 2020. Thieme. All rights reserved. ▶ Fig. 7 Femoral bifurcation. a The figure shows the anatomy of the bifurcation of the common femoral artery into the superficial and deep fem- oral arteries (shown in green) immediately after the inguinal ligament.
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